Medical Advances and Breakthroughs

Called natural orifice translumenal endoscopic surgery (NOTES), such operations include removing gallbladders and appendixes and repairing hernias through the patient's mouth or vagina. There's only a small puncture in the belly button, where the surgeon inserts a minicamera and a light to help guide the procedure.

Several centers around the country, including the UC San Diego Medical Center, New York-Presbyterian Hospital in New York City, and Northwestern Memorial Hospital in Chicago, are performing the surgeries now, and more are expected to start as companies develop the specialized instruments the procedures require.

Unlike standard abdominal operations, NOTES avoids cutting through abdominal muscles. External incisions not only are painful, but also can take weeks to fully heal and can cause complications like hernias. The small internal cuts that NOTES surgeons make, generally in less sensitive internal organs like the stomach or vagina, heal quickly and are not exposed to germs. "An open wound can cause an infection," says Qua's surgeon, Santiago Horgan, M.D., chief of minimally invasive surgery at UC San Diego Medical Center. "With the tiny puncture hidden deep in the belly button, we minimize that risk while achieving a scarless cosmetic result."

At first, Qua wasn't thrilled at the idea of having her gallbladder removed through her vagina. But having had major scoliosis surgery in her teens, she knew what being cut open and having stitches meant. "I wanted to avoid that pain and long recovery," she explains.

Her decision was the right one. "My sister had her appendix removed through traditional abdominal surgery and was wiped out and in bed for two weeks," Qua says. "I needed a painkiller for just two or three days. A week later, I was back to my regular activities, even chasing the kids at school, with only a little tenderness around my belly button."

Mood-Lifting Implants

Some 18 million Americans suffer from major depression. Of them, about one in five never gets better, no matter what therapy is tried.

Leslie Schaefer, 55, fell into that so-called treatment-resistant group. Her problems began when she was about 20, newly married, and starting a family in Rockport, MA. She worked at a bank and enjoyed teaching Sunday school.

At first, her mood was just off-kilter, though sometimes she experienced mania  periods of wildly elevated emotion and extreme energy. "I'd stay up half the night washing and ironing sheets," she says. She took the drug lithium to regulate her moods, but eventually the swing tilted in the opposite direction and stayed there.

Schaefer was so depressed she was barely able to leave the house. The simplest tasks became overwhelming. "I had so little concentration, I'd get lost going to the grocery store," she says. Once she wandered away from her home and ended up in a nearby park, where her frantic family found her  hours later  asleep on a bench.

Schaefer was hospitalized several times for her depression and, through the years, tried everything  counseling, drugs, even electroshock therapy. "All that did was destroy memories of my three daughters," she laments. She even considered taking her own life.

Then, two years ago, Schaefer's doctor helped enroll her in a study of a pioneering treatment called deep brain stimulation at Boston's Massachusetts General Hospital. Already approved for treating patients with Parkinson's and other neurological disorders, DBS is a kind of pacemaker for the brain. The battery-powered unit is placed in the chest, where it sends electric signals to receivers that have been implanted in specific brain regions, correcting abnormal activity associated with depression.

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